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For years, Zambia’s Ministry of Health (MoH) faced significant challenges in mobilising and efficiently utilising domestic resources to ensure sustainable healthcare financing. The absence of a dedicated Health Financing Unit (HFU) hindered strategic planning, leading to inefficiencies in resource allocation and policy implementation. It is in this regard that African Institute for Development Policy (AFIDEP) and Partners in Population for Development–Africa Regional Office (PPD-ARO), through the Advance Domestic Health Financing (ADHF) project, stepped in to support the MoH in revitalising its health financing structures, a move that is demonstrating remarkable impact.

A strategic intervention

The ADHF project played a pivotal role in establishing the HFU, supporting the Ministry of Health in assembling a dedicated team of three experts to drive health financing initiatives. With the placement of a Chief Health Financing Officer, Principal Planner, and Health Economist, the project enhanced technical expertise, spearheaded financing reforms, and strengthened the Ministry’s capacity to take ownership of sustainable health financing strategies.

One of the most significant outcomes of this intervention has been the revitalisation of the Health Financing Technical Working Group (HCF-TWG). The HCF-TWG comprises representatives from key stakeholders, including Ministry of Health, Ministry of Finance and National Planning, Ministry of Local Government and Rural Development, National Health Insurance Management Authority, Churches Health Association of Zambia, Private Sector Alliance, Healthcare Federation of Zambia, civil society organisations, development partners, and academic and research institutions. With a clear mandate, the HCF-TWG now provides critical technical guidance on policy development, strategic planning, and financing mechanisms. The project facilitated the development of comprehensive Terms of Reference (TORs) that define the roles and responsibilities of the working group, ensuring efficient coordination among government agencies, development partners, and civil society organisations.

Strengthening accountability in resource utilisation

ADHF also played a pivotal role in enhancing financial accountability in the health sector. Historically, internally generated funds (IGFs) from user fees were underutilised or mismanaged due to weak financial oversight, corruption, poor planning, and lack of transparency and accountability, limiting their potential impact. In collaboration with the MoH, ADHF supported the development, approval and adoption of guidelines for managing IGFs, rolled out in January 2025 by the Ministry of Health. These guidelines introduce a structured approach to fund allocation and reporting, ensuring greater transparency and accountability. By implementing these measures, health facilities will be able to direct resources more effectively, improving service delivery through better allocation of funds for medical supplies and essential services.

Empowering decision-makers with data

Without the most up-to-date data, the MoH struggled to make informed decisions on health financing. Reliable data is the foundation of sound policy decisions, yet Zambia had not updated its National Health Accounts (NHA) since 2017.  To bridge this gap, ADHF supported the update of the NHA for the period 2018–2021.

This update provided the MoH with a comprehensive analysis of health expenditures, shedding light on funding sources, resource allocation, and spending patterns. The insights gained have already informed budgeting decisions, particularly in addressing underfunded areas such as primary healthcare. The results of this work formed part of the evidence base used by the Ministry of Health to lobby for more resources for PHC eventually contributing to increased allocation from ZMW 7,526,482,775 (USD 278,758,621.00) in 2024 to ZMW 8,432,981,709 (USD 312,332,655.89) in 2025, a 12% increase. Additionally, training sessions conducted for MoH officials have built their capacity to regularly update and utilise NHA data, ensuring that evidence-based decision-making remains a cornerstone of health financing in Zambia.

A lasting impact

The strategic interventions supported by ADHF have had a profound impact on Zambia’s health financing landscape. The establishment of the HFU, the revitalisation of the HCF-TWG, the introduction of accountability measures for IGFs, and the update of the NHA have collectively laid a strong foundation for sustainable health financing.

Reflecting on this transformation, Mr Lucas Zulu, Assistant Director of Policy and Planning at the MoH, emphasised the critical role of ADHF’s support:

“The support from the ADHF project by AFIDEP and PPD-ARO has been pivotal in setting up the Health Financing Unit and the revitalisation of the HCF-TWG which mark significant milestones in Zambia’s journey toward sustainable health financing. These efforts have laid the groundwork for the development and implementation of innovative financing mechanisms, improved resource allocation, and enhanced accountability in the health sector. As the MoH continues to grow its Health Financing Unit, the technical support provided by the ADHF will remain critical in driving forward the health financing agenda.”

Conclusion

As Zambia continues to refine and strengthen its health financing structures, the impact of ADHF’s interventions will endure, ensuring that resources are effectively mobilised and utilised to improve healthcare delivery for all Zambians.

The ADHF project works with governments in Africa by providing technical support, evidence generation, capacity development and intensified advocacy for domestic health financing, all towards realising universal health coverage. The project is a joint initiative between the AFIDEP and PPD-ARO.